Today we have had our appointments for the first dose. But because the vaccine location is in a different county from where we live, that county decided to cancel us.
Actually, it sounds like we would have had a DMV-like experience. I’m not feeling sad.
Note that the average daily death rate in the U.S. is about 5 times it was this summer. If the vaccine is 90 percent effective, that means that my risk after vaccination is 1/10 of what it was without vaccination. Combining the two, that means that after the second dose and the vaccine has taken hold, I will have half the risk that I had this summer. That does not make me excited about getting out and circulating, even with the vaccine.
I will feel better if after a couple of months there are signs that the vaccine is reducing the incidence of the virus in the whole population. In a sense, getting the vaccine early is like getting onto a tour bus early. The bus isn’t going anywhere until more people are on board.
By the way, I think that Alex Tabarrok’s idea of giving first doses to more people and second doses to fewer people is unlikely to work in a free society. From society’s perspective, it may work more quickly to eradicate the virus. But from an individual perspective, I would rather wait to get two doses than get one dose and have to live with uncertainty about what happens next.
Speaking of the virus, the asymptomatic spreader fight never ends. Daniel P. Oran and Eric J. Topol write,
Today, the best evidence suggests that about half of Covid-19 cases are caused by infected people who do not have symptoms when they pass on the virus. These symptom-free spreaders are roughly divided between those who later develop symptoms, known as pre-symptomatic individuals, and those who never develop symptoms.
On the politics of the virus, Christopher J. Snowdon writes,
I suppose my position is boringly centrist. If you want a more invigorating take, you might be drawn to the Zero COVID strategy supported by “Independent” SAGE or the plan laid out in the the Great Barrington Declaration to shield the vulnerable and achieve herd immunity the old-fashioned way. Both of these options carry significant downsides and have now been made redundant by the vaccines, but whilst these ideas might have been flawed or unrealistic, they were not crazy. The former had worked in New Zealand and the latter had been the preferred policy of the chief medical officer until the hasty U-turn of March 2020. These were ideas that reasonable people could debate without being considered cranks.
But now, in the final months of this nightmare, the conversation among many of the noisiest lockdown sceptics has become decidedly cranky.
He speaks as a libertarian, policing his own side. Policing your own side is very honorable, in my view. It is the best way to fight polarization.
But libertarians can be more correct than others give them credit for. See Jacob Grier, who points out the many way government failures in the pandemic. Pointer from Tyler Cowen.
This reminds me that my main problem with “state-capacity libertarianism” is that the phrase itself assumes away, or at least downplays, the main reason I have for leaning libertarian. That is, there are structural reasons for state performance to be worse than you would expect and for market performance to be better than most people would expect.
“There are structural reasons for state performance to be worse than you would expect and for market performance to be better than most people would expect.”
That is almost a Klingism but it is not terse and aphoristic. It could be used as an expansion for a Klingism–perhaps to explain why you say “Markets fail–use markets.”
Arnold; What you need to know before drawing conclusions about risk is – when they say 90% protection, what is really driving that? We know that in a small population within the normal population, the vaccinated few had 10% incidence relative to the placebo. But was this because 10% did not respond to the vaccine and the others have effectively 100% immunity? Or because it takes a much larger dose for the vaccinated people to become infected? These kinds of details matter when extrapolating to a new background environment; new strain, different infection pressure, and so on. Also, if there are proxies for protection, so that one could tell whether the vaccine was working, that would change everything if there is a heterogeneous response to the vaccine…
“But from an individual perspective, I would rather wait to get two doses than get one dose and have to live with uncertainty about what happens next.”
I have a difficult time understanding this. My understanding of the evidence is that, while a single dose is less effective than the full two-dose course at preventing infection (70-85%[??] vs. 90-95%), a single dose does effectively eliminate the risk of serious infection (i.e. ~100%).
Yes, there are still uncertainties involved and perhaps even mild infections can cause ramifications down the road…But if you give me a choice between: (i) take the vaccine today and be assured that I won’t go on a vent in a hospital; or (ii) wait 6 months in exchange for a 20% increase in my overall immunity to infection, I will take the first option every single time. Everyone should
It’s Snowdon, now Snowdown.
Good piece, by the way. One of the few that doesn’t make lockdown skeptics into straw men.
Arnold, to clarify on effectiveness: the Moderna 3d stage clinical had 15K vaccinated, 15K placebo. Of the placebo group 185 caught Covid; of the vaccinated, 11 which is 5.9% of 185, so the Moderna vaccine was said to be 94.1% effective. We do not know how asymptomatic or sick the 11 were, but we do know that none of them were hospitalized.
We are not worried about people getting a little under the weather, we are worried about serious illness and death. And in that regard, it could be said the vaccine was 100% effective. That is a fantastic record; no other vaccine comes anywhere close.
I want to know how symptomatic or sick the 185 in the placebo group were. Just getting COVID isn’t that big of a deal if you are just a bit under the weather. The risk of serious illness below a certain age/comorbidity combination seems very low anyway, so I wonder if it is even practically noticeable. Much like how a cold can be cured within 5-7 days, but untreated could last up to a week.
You gotta do what you gotta do.
However, if that’s the case, isn’t removing yourself from the queue the ethical approach? Perhaps give your spot in line to someone with a higher risk tolerance so that he/she can move on?
Snowdon seems about three-quarters right. One ought consider that the shut downs are correlated with other public health outcomes. Foe example: https://www.theguardian.com/society/2020/sep/01/male-suicide-rate-england-wales-covid-19. And there are other mortality rate changes that may or may not be related to underreported covid cases: https://fingertips.phe.org.uk/static-reports/mortality-surveillance/excess-mortality-in-england-latest.html
On the first doses first controversy it seems like Tabarrok and Cowen are not really steel-manning their arguments. Capretta at AEI seems to have the better of it, especially since, as Steve Sailer points out, the delay in the Johnson & Johnson single dose vaccine, that is being subjected to an actual single dose trial, might indicate good results since they have not gotten enough positive cases yet. What perverse incentives would simply tossing out protocols and trial results have on future trial planners? At any rate, it would seem that if J&J get an EUA, that debate should be put to bed. The question then will be should people wait for the tested single dose or get the first available not knowing whether they will actually be able to get a second dose.
Capretta also seems to have the better of it on an Astra-Zeneca approval as well. Going ad hoc on an ad hoc basis seems suboptimal, why not just go ad hoc formally and approve anything that looks good based on non-USA trials.
Having assisted relatives even older than myself get registered online for vaccinations, I discovered that the necessity of reporting one’s race to be considered for vaccination doesn’t increase some peoples’ confidence in governance. The fact that teachers who are not going to be teaching anyway are jumping to the head of the line. And politicians bucking the lines doesn’t help either.
Was out and about before Christmas to do some shopping. But being outside in a relatively less dense area in a county with relatively few cases didn’t seem particularly risky because the stores were empty on weekdays anyway. The gas bill is taking a bit of a hit as I remain convinced of the benefits of airing the house out regularly. The electric bill is up a bit due to running air sanitizers constantly. Had a couple of bouts of runny nose which may or may not have been covid, the symptoms did not warrant testing, but taking beet powder prophylactically has slightly increased oxygen saturation. Other than masks and shutdowns, practical prevention seems oddly ignored.
Thucydides and Alabamian above are right. The real story with both the Pfizer and Moderna vaccines is that they were ~100% effective at eliminating serious disease.
If severe Covid resulted in spontaneous explosive diarrhea rather than death, Cosmopolitan would be running stories on what to do if you $#@! your pants while hooking up with a hot guy and Depends would worth more than Tesla.
Related to this, even though I’ve been a severe Covid-avoider since before it was cool (I bought my box of N95s in February last year), I said to a friend recently that if news came out that the vaccines failed completely and we would have to start over, my first move would be to go to my favorite steakhouse down the street, sit at the bar, and order martinis until I fell off the stool.
I
amwas a restaurant critic (as in paid by a newsstand glossy) on the side to give an idea of my pre-Covid lifestyle, and I haven’t sat down at a bar or table anywhere since February 29th. I conservatively figure my odds with Covid run from 1:200 for a hard ride to 1:400 for death, based on doubling my age-based risk given that I’m male, fat, and hypertensive.These past 10 months have been the saddest and least joyful of my post-adolescent life, even against the same period after my father died suddenly. If keeping this up for another 6 months means I have a shot at a near-perfect vaccine, then I’ll keep playing to win that game. But if that option expired, then the game matrix changes pretty sharply.
“I would rather wait to get two doses than get one dose and have to live with uncertainty about what happens next.” What will happen next if first doses are given widely (in preference to second doses) is that the epidemic will subside more quickly and it will sooner be safe for you to return to normal life. Life will still be uncertain, but the odds will be more in your (and our) favor.
If you reconcile the excess mortality with the claimed COVID deaths, then the COVID deaths are definitely being overcounted vs Summer since November. Excess mortality has been no worse in the last 3 months than it was in June-September. So that 5 times higher is a mistaken belief, Arnold.
“But from an individual perspective, I would rather wait to get two doses than get one dose and have to live with uncertainty about what happens next.”
No, the smart thing is to get the first dose now, because most of the immunity comes from the first dose. There is little indication that the second dose adds much, and some even believe that a longer wait time between doses grants better long term immunity.
“If the vaccine is 90 percent effective, that means that my risk after vaccination is 1/10 of what it was without vaccination. ”
My understanding is that its efficiency against having a severe case of the disease is almost 100%, which is the only outcome that should really be causing a change in behavior.
If you can transfer your appointment to me, I will gladly take it.
“But now, in the final months of this nightmare, the conversation among many of the noisiest lockdown skeptics has become decidedly cranky.”
There were two points in his article I thought made some sense.
1) The case for lockdowns is stronger if vaccines are right around the corner, because the cost of lockdowns is well defined and shorter.
2) If the new virus variant really is fundamentally different from the old in some way, it may warrant different actions then the old virus variant.
He doesn’t always phrase it that way, but it’s the best reading of the article.
For lockdown skeptics, they don’t really get to the heart of the issue though:
1) That the lockdown was justified when there was no end in sight and no prospect of vaccines. And with no cost/benefit analysis done.
2) That the lockdown was justified based on the old virus variant, and if we want to say a new debate is warranted for the new one so be it, but that doesn’t justify the old lockdown.
Myself, I have become a skeptical of the very idea of locking down. I was willing to give the benefit of the doubt in March, but I was insufficiently alarmed by what government would do with that power once it had it. Had I properly understood that “once you lockdown, you can never stop, no matter what new data comes up” then I would have rolled the dice on COVID being mass death.
Put more directly, we are going to get another virus with COVIDs profile in the future (or just a vaccine resistant COVID), and at that time I want lockdowns off the table. So we have to continue the fight.
I know a number of physicians including some specialists in the field, and the universal opinion among them is that the safe window opens 7-14 days after the second dose.
Many of them have been running antibody tests on vaccine recipients, and they’re seeing that while most people show a response within 2 weeks of the first dose, at least 10-15% don’t until 7+ days after the second. They also suspect there are some systematic differences between the Moderna and Pfizer vaccines as the Moderna shot includes a lot more mRNA than the Pfizer one and it encodes slightly differently.
Your second point, that a longer delay between doses 1 and 2 might be better, is widely suspected among them. Thus, from a public health standpoint, it’s very likely true that we’d do better to increase to a 45- or 60-day interval and get more first doses out there, but at a personal level, these physicians are counseling vulnerable relatives and patients to wait until 2nd dose +7 to make a restaurant reservation.
“That the lockdown was justified when there was no end in sight and no prospect of vaccines. And with no cost/benefit analysis done.”
Blah blah blah. Please forward over that cost/benefit analysis so that we can all have a look. Lol…I’m sure no one would disagree with it since utils can be objectively evaluated and summed between individuals.
And, you were more than welcome to employ the precautionary principle at the outset if that was your preference, but that was just one of many approaches with none being better than the other ex ante based on what we knew in March.
No, the smart thing is to get the first dose now, because most of the immunity comes from the first dose.
Yes but … The second dose is mainly to “boost” the first dose, to keep the immunity going. No one knows how long it takes the immunity from the first dose to “decay”, simply because no one (outside the clinical trials) has had the first dose for more than a month or so.
Not knowing something for absolute certain isn’t a reason to not do something.
“Note that the average daily death rate in the U.S. is about 5 times it was this summer. If the vaccine is 90 percent effective, that means that my risk after vaccination is 1/10 of what it was without vaccination.”
Can someone please explain how this logic works? I understand how the 1/10 was derived, but trying to understand the statistical logic in it. E.g. if the deaths were 100x what they were over the summer, does this have any bearing whatsoever on the efficacy of the vaccine?
It does not have any effect on the efficacy of the vaccine. But your operational choice is “How should I live my life all things considered?” So you need to consider not just the efficacy of the vaccine, but also how much more exposure you are getting.
The vaccine is less like a rubber bubble and more like a spaghetti strainer. Stuff gets through, just less of it. Lets say without it, you have X% chance to get sick from every minute of exposure to a sick person, and with it, you have x% chance to get sick for every minute of exposure.
In the summer, you run into 100 sick people minutes you have 100X% chance to get sick. In the winter, you run into 100,000 sick people minutes and you have 100,000x% chance to get sick.
Is your risk higher or lower? Depends what X/x is, and how the 100 -> 100,000 actually changes.
Hopefully that makes sense to those of you not addled by years of engineering school and sabermetrics.
Oran and Topol apparently did not read the paper they refer to. The paper is an “analytical decision model”, not the best available evidence, not even an evidence, and is a total rubbish.
The paper starts with “The baseline assumptions for the model were that peak infectiousness occurred at the median of symptom onset and that 30% of individuals with infection never develop symptoms and are 75% as infectious as those who do develop symptoms.” That is, the assumption is that asymptomatic individuals are almost as infectious as those who develop symptoms.
I was pretty skeptical of that figure as well. I’m gonna look at the paper too, ty for the pointer.
I think one way to think of state capacity neutrally is to ask questions like: Even if we assume a private educational system would be better, why are some countries so much better at setting up and running a public school system (think Singapore) than the US? Why is China better at infrastructure and city building than India? This is not for or against the virtues of that system, or its democratic failings, but a question of how well the state can act given similar projects and funding?